Análise dos valores de composição corporal em homens com diferentes níveis de lesão medular

Differences of Relative and Absolute Strength of Individuals With Spinal Cord Injury From Able-Bodied Subjects: A Discriminant Analysis

CONTEXT

Strength training is one of the most common interventions employed to increase functional independence during rehabilitation of individuals with spinal cord injury (SCI). However, in the literature, different results have been reported in terms of strength modifications after a SCI compared with a control group (CG).

OBJECTIVE

This study aimed to verify whether discriminant analysis using relative and absolute strength is able to discriminate individuals with different levels of SCI from a CG and to compare strength values of men with different levels of SCI with a CG.

DESIGN

Cross-sectional study.

SETTING

Rehabilitation hospital setting.

PARTICIPANTS

A total of 36 individuals with SCI stratified in tetraplegia (TP; C6-C8), high paraplegia (HP; T1-T6), and low paraplegia (LP; T7-L2), and 12 matched control subjects were enrolled in the study.

MAIN OUTCOME MEASURES

The subjects performed a maximum strength test of elbow extension/flexion and also shoulder abduction/adduction and flexion/extension in an isokinetic dynamometer. Discriminant analysis was carried out to identify which strength variables would be able to discriminate the TP, HP, or LP groups from the CG. A 1-way analysis of variance was performed to compare peak torque and agonist/antagonist ratio means.

RESULTS

Shoulder adduction, followed by elbow extension peak torque, was the best variable for discriminating the TP group from the CG (function coefficients: -0.056 and 0.051, respectively, Wilks Λ = 0.41, P ≤ .05). There were no significant differences between the HP group, LP group, and CG.

CONCLUSIONS

The strength similarity of the paraplegic groups and the CG should not be extrapolated for activities of daily living or sports. The TP group demonstrated lower peak torque for all movements than the CG.

The addition of three new items in the Adapted Manual Wheelchair Circuit improves the discrimination between different levels of spinal cord injury

Purpose: To determine whether the inclusion of three additional items improved the discriminative capacity of the Adapted Manual Wheelchair Circuit (AMWC). Design: Cross-sectional study. Methods: A total of 126 men (median age 28.9 years [percentiles 25 and 75: 23.7; 38.5 years]) with spinal cord injury were consecutively enrolled and divided into three subgroups: high paraplegia (HP), medium paraplegia (MP), and low paraplegia (LP). The participants performed the AMWC with three additional items. Ability score and total time of AMWC (AMWC_AS and AMWC_TT) and AMWC plus the three additional items (AMWC+3_AS and AMWC+3_TT), 3 min of overground wheeling test and performance score were evaluated. Results: AMWC was not able to discriminate HP from MP and LP (Wilks' lambda = 0.93; P= 0.07). In contrast, AMWC+3 was able to discriminate between the three subgroups (Wilks' lambda = 0.86; P≤ 0.05). AMWC+3_AS presented a better sensitivity compared to AMWC_AS (lower success rate for all subgroups, 38.5% vs. 82.1% for HP; 49.0% vs. 75.5% for MP; 78.9% vs. 94.7% for LP). The LP group presented a significant higher AMWC+3_AS compared to MP and HP (17.0 vs. 16.5 and 16.5, respectively, P≤ 0.05). AMWC+3_TT was significantly lower in LP compared to MP and HP (139.85 s vs. 242.52 s and 326.21 s, respectively, P≤ 0.05). Conclusion: The AMWC+3 outcomes were able to discriminate between HP, MP, and LP subgroups, and the addition of the three items enhanced the sensitivity of the wheelchair circuit. The performance of LP was more evident with significant differences compared to HP and MP for all AMWC+3 outcomes.

Cross-cultural validation of a Brazilian version of the adapted manual wheelchair circuit (AMWC-Brazil)

Purpose: To translate, culturally adapt and validate the Adapted Manual Wheelchair Circuit (AMWC) into Brazilian-Portuguese. Design: Cross-sectional study. Methods: Sixty-six men (median age of 30.5 years [percentiles 25 and 75: 24.0; 38.3 years]) with traumatic spinal cord injury were consecutively enrolled and divided into two groups: tetraplegia (TP) and paraplegia (PP). The participants performed the AMWC-Brazil and were evaluated by the Spinal Cord Injury Measure version III (SCIM-III). Translation, translation synthesis, back-translation, committee review and construct validity were adopted for the cross-cultural adaptation. Construct validity was performed by testing whether the test scores were significantly correlated (Spearman's correlation coefficient) to the subjects' injury level, age, time since injury, body mass index (BMI) and SCIM-III scale. Results: All the AMWC-Brazil's outcomes were significantly correlated with SCIM-III total score and subscales (P ≤ 0.01). However, when the analyses were stratified over injury level, only the TP showed a high correlation between the AMWC-Brazil's outcomes and the SCIM-III. For construct validity, 4 of 5 hypotheses were confirmed. Only BMI was not a significant predictor of the AMWC-Brazil outcomes. Conclusion: The AMWC was successfully translated to the Brazilian-Portuguese (AMWC-Brazil) and presented high and satisfactory construct validity.